What is a Tummy Tuck (Abdominoplasty)?
An abdominoplasty is an operation in which excess skin and fat from the abdominal wall, particularly below the navel, is removed and the remaining skin tightened. This is accomplished by elevation of the skin and fat, tightening the underlying muscles if necessary, pulling the excess skin downward, and excising the excess. It is particularly effective in removing stretch marks from the lower abdomen, but it must be understood that not all stretch marks can be eliminated, and that some laxity, particularly noticeable when flexing the hips, will persist. The same navel is reinserted into the skin after the tightening procedure.
Frequently, particularly after childbirth or weight loss, patients present with a weakness of the abdominal wall muscles; in such cases, the defect between the anterior muscles is repaired (“fascial repair”) before trimming the excess skin and fat.
This procedure can be combined with other abdominal or non-abdominal operations such as liposuction, facelifts or other procedures.
The operation is directed toward an improvement and does not in any way guarantee complete obliteration of all folds and stretch marks. You must accept the judgment of your plastic surgeon and realize that he/she will remove as much as is safe and suitable. Particularly in patients with thicker abdominal walls or marked skin excess, it may be desirable to return for a secondary liposuction of the abdominal wall or an additional skin excision to obtain an optimal result. Should this prove desirable, the patient will be responsible for all costs associated with all secondary surgical procedures.
The type of skin, degree of elasticity and age of the patient all influence the overall result that is obtained. The operation should not be undertaken if the patient intends pregnancies in the near future. Should a patient become pregnant after an abdominoplasty, a normal pregnancy will ensue but the abdominal wall will again get stretched. While it is not necessary for the patient to reach a certain weight before surgery may be performed, it is desirable that the patient’s weight be stable for at least six months prior to surgery and that the patient be at a weight he/she feels can be maintained after the procedure.
A common question is, “How long will the results of this procedure last?” This is impossible to state. Factors affecting the length of the improvement include physical conditioning afterwards, type of skin, and alterations in weight. In general, it is not necessary to repeat this procedure to maintain the optimal result. It should be noted that this procedure removes the skin and fatty excess that a patient has at the time of the abdominoplasty but does not prevent a patient from gaining weight and stretching the abdominal wall again in the future. Should a patient wish to repeat the operation, regardless of the length of time since the initial operation, the degree of laxity or fatty excess remaining, each patient will be responsible for the cost of a subsequent procedure.
Tummy Tuck Overview Video
The following information has been prepared to familiarize you with facts about the surgical procedure known as abdominoplasty (“tummy tuck”) or abdominal fascial repair. You are requested to read this information thoroughly and to discuss any questions which might arise with your surgeon before you give your consent to proceed with this procedure. You are also requested to keep this form as a reference in the postoperative period.
Preoperative instructions
You may visit your surgeon as many times as you wish, to have all of your questions answered. At your preoperative visit (which takes an hour or more), your final questions will be answered and you will confirm that you understood the procedure to be performed, that this material has been explained to you, that you have read and understood these information sheets, and that you accept the risks by signing the informed consent forms. You will be given prescriptions for surgical soap that will be used before surgery, as well as for pain pills and antibiotics, along with instructions for their use. Certain laboratory tests will also be required within two weeks of surgery. If you are over the age of 50, you will have to obtain a cardiogram at your doctor’s office or any licensed laboratory. You may have blood drawn by our office nurse during your final preoperative visit, or, if you prefer, at your family doctor’s office or other laboratory (e.g. Kaiser Hospital, etc.). Smoking constricts blood vessels and hinders normal healing – all smokers will be asked to stop smoking three months prior to surgery in an effort to maximize your body’s ability to heal the incisions following the operation.
It will be necessary to scrub the chest, abdomen, groin, flank regions, and thighs for ten minutes the evening prior to surgery and a final time the morning of surgery before leaving home. Washing the surgical site these two times with Hibiclens® soap will lower the possibility of an infection occurring after surgery.
Ordinarily, your anesthesiologist will call you the night before surgery to discuss the anesthetic care plan with you. But if you miss the call or your anesthesiologist does not call you, do not worry as you will be able to discuss your anesthesia and have all your questions answered in the morning, at the Surgery Center, prior to your procedure. You must make arrangements to have someone drive you to and from the Laguna Hills Surgery Center and stay with you at home for the first two or three days afterwards. Arrangements can also be made to have a registered nurse care for you for the first night or two as well, either at your home or at the Ayers Hotel adjacent to the Surgery Center.
Details of the procedure
The operation will be performed in an outpatient facility under very deep sedation or light general anesthesia, supplemented by local anesthetics. An incision is made across the lower end of the abdomen, and the skin and fat of the abdominal wall are elevated to the rib margins. The navel remains attached to the abdominal wall, but is released from the surrounding skin and fat through a diamond shaped incision around the navel. The abdominal muscles are tightened by suturing them together in the midline. These internal sutures are permanent but all of the remaining sutures used for the skin closure are absorbable. The excess skin and fat from the lower abdomen are trimmed.
On occasion, it may be appropriate to suction some of the excess fat that can not be resected, but there is a limit to how much can be removed without jeopardizing the viability of the skin flaps. A new opening is created in the skin of the abdominal wall to reinsert the navel. Drains and pain pump catheters are inserted prior to suturing the wound closed. The pain pump catheters are connected to a reservoir that contains local anesthetic solution that will automatically infuse into the surgical site for the first three days or so to minimize your discomfort. The pain pump catheters are optional (strongly recommended) but all patients will have drainage tubes inserted. The drains remove excess blood and serous fluid and will be removed after the drainage has decreased to less than 25-30 cc. (about an ounce) of fluid per day. This usually takes about a week to ten days but can take up to a month.
Post-operative care
Adequate pain medication will also be prescribed. All patients, who go home on the day of surgery, will find that an assistant at home is a necessity for the first three days or so. This can be a family member or a trained nurse. High bulk foods are highly encouraged and laxatives may be necessary to prevent straining associated with constipation.
Patients will be encouraged to walk as much as possible at home after surgery as this will reduce the possibility of pneumonia or of clots forming in your calf veins. It will be necessary to keep the hips gently flexed for the first week to minimize discomfort and to prevent excess tension on the suture lines. Each patient is allowed to stand up straight when comfortable doing so. Patients will be allowed to shower after the drains have been removed, but soaking in a bathtub is to be avoided for two weeks. Wounds are generally closed with absorbable buried sutures. The incisions are covered with surgical adhesive, which will wash/peel off spontaneously over a few weeks. It is recommended that patients begin applying ScarGuard® (or another suitable scar cream or ointment to optimize healing) as the adhesive begins to peel off about two weeks after surgery. The ScarGuard® should be applied daily as directed until the scar has finished healing.
Your first post-operative visit will generally be scheduled three to four days after surgery at which time the pain pump catheters will be removed. The drainage tubes will be removed at a subsequent visit. You should continue taking antibiotics as long as the drainage tubes are in place. You will be required to have someone drive you to the office for your first and second visits. Most patients find that they can gradually increase their activity levels thereafter. You may drive a car with caution, wearing a safety belt, beginning 48 hours after your last pain pill or sedative, if you feel comfortable and physically able to do so.
Possible complications
Serious complications after an abdominoplasty are relatively uncommon. However, there will be a long scar (usually, but not always, within the bathing suit line) extending from hip to hip. The scar may remain itchy, painful, thick, or otherwise unsightly. It is unusual, but possible, for areas of fat to liquefy and drain through the incision for many months, or to cause a tender mass to develop beneath the skin, which may require excision at a later date. As with any abdominal procedure, it is also possible for a suture to become infected and to erode through the skin years later.
One of the most common problems after an abdominoplasty is a persistent collection of serous fluid under your skin after the drains have been removed. Should this occur, this fluid will be aspirated with a needle during your post-operative visits. Such drainage always stops eventually (but may persist for more than a month) and usually does not affect the final results. If wound problems develop, it may take several weeks or even months for healing to take place, and the patient will be required to wear dressings over the open wound. Because of the extensive skin and fat undermining, areas of skin may die and slough, or even require surgical debridement or a skin graft. Rarely, phlebitis may develop in leg veins and even more rarely, blood clots could travel to the lungs, potentially leading to a fatal complication.
Perfect symmetry does not exist before or after abdominoplasty surgery. Scars will never be identical from side to side and the umbilicus will not be exactly midline.
Secondary procedures may occasionally be desirable to revise scars, to excise more skin, or to thin the abdominal layer above the scar (usually with liposuction). The patient will be responsible for all costs associated with secondary surgical procedures.
It is not possible to list every conceivable complication. As with any operation, there could be potential complications, which could even be fatal. The foregoing is not intended to frighten or upset you but to enable you to make your decision with an understanding of some of the involved risks.
Fees and financing
If a significant spreading of the anterior muscles or a hernia is present, your insurance company may, rarely, reimburse you for a portion of the Surgery Center bill and of the professional fees. In some instances, it may be possible to verify the amount covered by your insurance carrier in advance; the office staff can assist you in making this determination, but cannot guarantee a level of payment. The office staff will provide you with the necessary information to submit to your insurance carrier. All fees are due prior to the surgical procedure and, if any portion of your procedure will be covered by your carrier, you will be reimbursed directly by your insurance company. Insurance carriers sometimes (rarely) pay for the muscle repair portion as this may be considered corrective surgery; they will not pay for the skin tightening or other purely cosmetic portions of the procedure. If desired, the office staff can also help you arrange financing for your procedure.
In compliance with suggestions adopted by the American Society of Plastic Surgeons, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This insures that the patient is sincere in his/her motivation and can afford the surgery, thus creating a better patient/physician relationship.
A non-refundable deposit will be required to secure your desired surgery date when booking your procedure. The remainder of the fees must be paid prior to the surgery, usually at the time of the preoperative visit, but never later than one week before surgery. Additional fees are also required for laboratory tests, surgical facility fees and the anesthesiologist. If additional surgical procedures become necessary, additional facility, laboratory, anesthesia, and professional fees will be incurred. The surgical facility and anesthesiologist fees quoted will be based on our best faith estimate; the final fee may vary as these fees are based on surgical time, and it is not always possible to predict exactly how long a procedure will take to complete. It is important that you understand that the patient is responsible for all costs associated with all secondary surgical procedures or for the treatment of any complications that may arise as a result of this elective surgery.
Pre and post-op photos will be taken of the treatment site for record purposes. I understand that these photos/videos will be the property of the attending physician. I do____, do not ___ agree to allow these pictures to be used for publication, teaching purposes or the practice web site. If I agree, I understand that my name will be kept confidential and protected.
IF YOU HAVE ANY QUESTIONS, DO NOT HESITATE TO CALL THE OFFICE DURING BUSINESS HOURS (949-888-9700) OR AFTER HOURS, CALL YOUR SURGEON – DR BUNKIS CELL PHONE NUMBER IS (949) 500-8856, OR REGISTERED NURSE, TRACEY PRESCOTT’S NUMBER IS (949) 338-6072.
WITH AN EMERGENCY THAT REQUIRES IMMEDIATE ATTENTION, CALL 911 BUT PLEASE HAVE YOUR FAMILY NOTIFY DR. BUNKIS OF ANY PROBLEMS YOU MAY HAVE!
I, _________________________________________________certify that I have read and understand the “Abdominoplasty/Tummy Tuck” information sheets dated March 2008, that my surgeon has answered all of my questions to my satisfaction, and that I give my informed consent for this procedure.
Witness_______________________________ Date__________________
I certify that I or a member of my staff has discussed all of the above with the patient and have offered to answer any questions regarding the procedure. We believe that the patient fully understands the explanation and answers.
Surgeon’s Signature_____________________ Date_________________
Initial if copy requested/given to patient____________________________
Copy placed in chart __________________________________________
Copyright 11/87 Last revised 03/08
Juris Bunkis, M.D., F.A.C.S.
How long should I wait until I can go out socially?
Social activity should be limited while the patient is uncomfortable. A good general rule of thumb is that patients should avoid any physical activity that causes discomfort. There is no set time table for resuming strenuous activity – just avoid activities that cause discomfort – but as a general rule of thumb for most patients, it takes approximately six weeks for the muscle repair to heal to a point where strenuous activity does not cause discomfort. Basically, most patients find that they can return to normal activity as the discomfort of the operation fades away. Office work can usually be resumed within 1-2 weeks of surgery, but the patient should expect a six-week delay before returning to physical labor or strenuous exercise. It will take longer than a year for scars to fade and the abdomen to feel relatively normal. The lower abdominal skin may feel numb forever and completely normal feeling is not to be expected.
